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Erschienen in: Knie Journal 2/2019

04.09.2019 | Konservative Therapie | Leitthema

Funktionsgewinn durch die VKB-Plastik

verfasst von: PD Dr. med. Matthias Krause, Fabian Freudenthaler, Karl-Heinz Frosch, Andrea Achtnich, Wolf Petersen, Ralph Akoto

Erschienen in: Knie Journal | Ausgabe 2/2019

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Zusammenfassung

Hintergrund

Die Ruptur des vorderen Kreuzbands (VKB) ist für die meist jungen, sportlich aktiven Patienten verbunden mit Langzeitkomplikationen wie einer Gonarthrose, Funktionseinschränkung und reduzierten Lebensqualität. Die VKB-Rekonstruktion stellt derzeit den therapeutischen Goldstandard zur Wiedererlangung der Kniefunktion bei symptomatischer Instabilität dar.

Fragestellung

Systematische Literaturanalyse zum funktionellen Outcome nach operativer oder konservativer Therapie in Abhängigkeit von der operativen Versorgungsqualität.

Methode

Es erfolgte eine systematische Literaturanalyse nach den PRISMA-Kriterien. Dabei wurde die operative Versorgungsqualität entsprechend der postoperativen anteroposterioren (AP-)Translation beurteilt.

Ergebnisse

Alle operierten Patienten zeigten eine stabilere AP-Translation als konservativ Therapierte. Eine signifikant bessere Kniefunktion nach operativer Versorgung wiesen 6 Beobachtungsstudien nach, in 7 Studien zeigte sich keine signifikant bessere Kniefunktion. Überlegene funktionelle Ergebnisse nach VKB-Rekonstruktion im Vergleich zur konservativen Therapie präsentierten 5 von 9 Analysen zur postoperativ wiederhergestellten Kniegelenkstabilität. Die durchschnittliche Studienqualität war niedrig. Häufigste Schwächen waren die fehlende Untersucherverblindung, der lange Versorgungszeitraum zwischen Verletzung und Operation, eine eingeschränkte Operationsqualität sowie eine fehlende Poweranalyse.

Schlussfolgerung

Tendenziell zeigen Patienten nach VKB-Rekonstruktion überlegene funktionelle Ergebnisse im Vergleich zur konservativen Therapie. Eine Gleichwertigkeit der konservativen gegenüber der operativen Versorgung konnte nicht nachgewiesen werden. Der konservative Therapieansatz versagt in bis zu 51 % der Fälle.
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Metadaten
Titel
Funktionsgewinn durch die VKB-Plastik
verfasst von
PD Dr. med. Matthias Krause
Fabian Freudenthaler
Karl-Heinz Frosch
Andrea Achtnich
Wolf Petersen
Ralph Akoto
Publikationsdatum
04.09.2019
Verlag
Springer Medizin
Erschienen in
Knie Journal / Ausgabe 2/2019
Print ISSN: 2662-4028
Elektronische ISSN: 2662-4036
DOI
https://doi.org/10.1007/s43205-019-00002-6

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